RSM’s Medical apps: mainstreaming innovation with Matt Hancock

February 28, 2019 | by

This event on 4 April run by the Royal Society of Medicine’s Digital Health Section continues the successful series started by this editor (now no longer involved) seven years ago. It will examine the growing role that apps are playing in healthcare delivery.

Join colleagues to hear renowned speakers, including the Secretary of State for Health and Social Care, Matt Hancock, discuss the current and future part apps can play in the NHS and broader healthcare industry. We will hear Wendy Clarke, executive director at NHS Digital talk about the new NHS app. As apps move from concept to pilot to practice, demonstrating efficacy becomes increasingly important, so will be looking at how we can best assess clinical effectiveness. It is well recognised that poorly designed software can hamper rather than enhance healthcare. Matt Edgar Head of design for NHS Digital will talk of the importance of good design in medical apps, and how it can improve patient and clinician experience. The use of cutting edge technology in healthcare necessarily opens new regulatory and legal issues. We are pleased to have our legal counsel, Julian Hitchcock back to share his experience with this, with a particular focus on the use of artificial intelligence in healthcare. We will also be examining the importance of interoperability, as medical apps become more mainstream, and how to make this happen. We have some presentations, too, from new and established medical start-ups, showcasing the transformative effects these new technologies can have. Finally, we will take a look at what the future may hold with futurologist Lewis Richards, Chief Digital Officer of Servest.

Aims:

This meeting aims to: 

  • Encourage clinicians to consider medical apps when deciding on an appropriate intervention
  • Aid understanding of the medicolegal issues around medical app use
  • Reduce the fear, uncertainty and doubt about the use of medical apps

Objectives:

By the end of this meeting, delegates will be able to,

  • Have an understanding of the current state of the art of medical apps
  • Explain the latest position on regulation and endorsement of medical apps
  • Have an appreciation of how to assess the clinical effectiveness of medical apps. 

Book here – best to book soon too, as currently the RSM has not allocated the largest lecture theatre to the event so it will almost certainly sell out.

Suddenly hot: chronic condition management in telehealth initiatives at University of Virginia and Doctor on Demand

February 28, 2019 | by

Chronic condition monitoring is suddenly hot. UVA has been a telehealth pioneer going back to the early oughts, with smart homes, sensor based monitoring, and remote patient monitoring. Their latest initiatives through the UVA Health System focus on preventing or managing chronic conditions. It will include remote monitoring for patients with diabetes, screenings for patients with diabetic retinopathy, home-based cardiac rehabilitation programs for heart failure patients and streamlined access by primary care physicians to specialists through electronic based consults. The program will also include specialized trainings for health care providers.

The programs are being funded by a $750,000 grant from the federal Centers for Disease Control and Prevention (CDC) and the Virginia Department of Health. UVA press release, Mobihealthnews

Mobihealthnews earlier noted that Doctor on Demand, a smaller commercial telehealth company, is also expanding in the management of chronic conditions through a new service, Synapse, that creates a digital medical home for personal data. This data can include everything from what is generated by fitness trackers to blood pressure monitors. The data can be directly shared with a provider or across health information exchanges and EMRs. Doctor on Demand plans to use this longitudinal data to identify gaps in care and increase access to healthcare services–and also integrate it into existing payer and employer networks.

This Editor recalls that this was a starting point for telehealth and remote patient monitoring as far back as 2003, but somehow got lost in the whiz-bang gadget, Quantified Self, and tablets for everything fog. Back to where we started, but with many more tools and a larger framework.

Events, dear friends: MedTech London, Aging 2.0 Philadelphia, speakers wanted for Connected Health Summit

February 28, 2019 | by

MedTech London, 11 April, London South Bank University

LSBU, SEHTA and the GLA have an event that blends commercial partnerships with academics and developing research collaborations.  The event also includes information on the latest NIHR Funding Programme and the Simulation for Digital Health programme supporting healthtech start-ups, SMEs and the Knowledge Transfer Programme Scheme by Innovate UK. The day’s agenda and registration is here.

Aging 2.0 Philadelphia: 13 March evening

Caregiving is becoming a new frontier for innovation. This free evening hosts a panel of caregiving and home care experts. More information and registration is here.

Connected Health Summit’s Call for Speakers: 27-29 August San Diego

Parks Associates’ Connected Health Summit has opened invitations for speaker submissions on two general topics–Innovation and Partnerships and Empowering Consumers with Connected Health–each with seven sub-topics. Interested applicants should submit here by 29 March. TTA has been a media partner of the Connected Health Summit over the past few years.

First they came for the fax machines….now NHS is coming for the pagers

February 27, 2019 | by

Bloop, Bleep. The NHS has officially announced the phasing out of pagers in hospitals by the end of 2021, with all hospitals required to have their plans and infrastructure in place by September 2020. Replacing pagers will be mobile phones, and smartphones with health communication apps, which facilitate two-way communications and coverage.

According to Digital Health, the pager-less pilot was at West Suffolk NHS Foundation Trust (WSFT), which is one of the Global Digital Exemplar (GDE) sites. The 2017 test resulted in junior doctors saving 48 minutes per shift and nurses 21 minutes on average. The platform  used was Medic Bleep, which integrates audio, text, image and file sharing on web, iOS, and Android. 

NHS is estimated to use about 10 percent of all pagers in use worldwide. The cost, according to this report in Bloomberg, is also stunning. Its 130,000 pagers cost £6.6 million ($8.6 million). A single device can cost as much as £400 pounds, which came as a great surprise to this Editor. Only one UK company, Capita Plc’s PageOne, even supports pagers. So this ‘War On Pagers’ as Digital Health dubs it, has some rationale. Supposedly, the NHS can keep some pagers for emergencies, when Wi-Fi fails or when other forms of communication are unavailable, but even that is doubtful as PageOne will likely go out of the pager business by then.

Mr. Hancock is quoted extensively in both reports. “We have to get the basics right, like having computers that work and getting rid of archaic technology like pagers and fax machines. Email and mobile phones are a more secure, quicker and cheaper way to communicate which allow doctors and nurses to spend more time caring for patients rather than having to work round outdated kit.”

In the US, pagers have largely been replaced by smartphones with advanced communication and file sharing/monitoring except in one specialty–psychiatry. Many psychiatrists in private practice retain their pagers and answering services as a needed triage between themselves and patients. (Over 55 percent of psychiatrists are also aged 55+.)

The King’s Fund Digital Health and Care Conference announces Matt Hancock as Day 2 keynoter

February 27, 2019 | by

The latest word is that the Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care, will be giving the keynote address on the second day (23 May) of The King’s Fund’s annual Digital Health and Care Congress. If you are UK-based or do business there, and you haven’t signed up…what are you waiting for? This link here or on the right sidebar will take you straight to the program site. When you’re there to register, don’t forget to use the code Telehealth_10 to get an exclusive 10 percent discount for our Readers. TTA is pleased to be again an official supporter of the Digital Health and Care Congress.

About time: digital health grows a set of ethical guidelines

February 27, 2019 | by

Is there a sense of embarrassment in the background? Fortune reports that the Stanford University Libraries are taking the lead in organizing an academic/industry group to establish ethical guidelines to govern digital health. These grew out of two meetings in July and November last year with the participation of over 30 representatives from health care, pharmaceutical, and nonprofit organizations. Proteus Digital Health, the developer of a formerly creepy sensor pill system, is prominently mentioned, but attending were representatives of Aetna CVS, Otsuka Pharmaceuticals (which works with Proteus), Kaiser Permanente, Intermountain Health, Tencent, and HSBC Holdings.

Here are the 10 Guiding Principles, which concentrate on data governance and sharing, as well as the use of the products themselves. They are expanded upon in this summary PDF:

  1. The products of digital health companies should always work in patients’ interests.
  2. Sharing digital health information should always be to improve a patient’s outcomes and those of others.
  3. “Do no harm” should apply to the use and sharing of all digital health information.
  4. Patients should never be forced to use digital health products against their wishes.
  5. Patients should be able to decide whether their information is shared, and to know how a digital health company uses information to generate revenues.
  6. Digital health information should be accurate.
  7. Digital health information should be protected with strong security tools.
  8. Security violations should be reported promptly along with what is being done to fix them.
  9. Digital health products should allow patients to be more connected to their care givers.
  10. Patients should be actively engaged in the community that is shaping digital health products.

We’ve already observed that best practices in design are putting some of these principals into action. Your Editors have long advocated, to the point of tiresomeness, that data security is not notional from the smallest device to the largest health system. Our photo at left may be vintage, but if anything the threat has both grown and expanded. 2018’s ten largest breaches affected almost 7 million US patients and disrupted their organizations’ operations. Social media is also vulnerable. Parts of the US government–Congress and the FTC through a complaint filing–are also coming down hard on Facebook for sharing personal health information with advertisers. This is PHI belonging to members of closed Facebook groups meant to support those with health and mental health conditions. (HIPAA Journal).

But here is where Stanford and the conference participants get all mushy. From their press release:

“We want this first set of ten statements to spur conversations in board rooms, classrooms and community centers around the country and ultimately be refined and adopted widely.” –Michael A. Keller, Stanford’s university librarian and vice provost for teaching and learning

So everyone gets to feel good and take home a trophy? Nowhere are there next steps, corporate statements of adoption, and so on.

Let’s keep in mind that Stanford University was the nexus of the Fraud That Was Theranos, which is discreetly not mentioned. If not a shadow hovering in the background, it should be. Perhaps there is some mea culpa, mea maxima culpa here, but this Editor will wait for more concrete signs of Action.

A short but canny look at consumer behavior as a driver of health technology

February 26, 2019 | by

Whether the global ‘smart home healthcare’ market actually totals $30bn by 2023, as a Research and Markets study trumpets, is debatable, but one thing that this Editor agrees with is that successful home health devices need to take a chapter from Steve Jobs’ Apple and famed industrial designer Raymond Loewy’s playbooks (search our Loewy references here) and design for how the consumer lives and would use their product. It isn’t flashy design awards, but how that technology can not only fit into a person’s life but also be an asset that they’d miss if someone took it away–a point often forgotten in the rush of initial design, testing, and funding.

Writer Scott Thielman of Product Creation Studio, a Seattle-based industrial design and engineering firm, outlines four health tech products/services that represent technology that is intuitive, easy-to-use, accessible, and, I would add, have a little something extra that makes them indispensable.

  • Athelas, a next-generation immune monitoring device that resembles an Amazon Alexa in being a 3D black cylinder. Instead of playing music, it measures neutrophils, lymphocytes, platelets, white blood cells, morphology, and cell activation all within minutes from a test strip inserted in the cylinder. (Investigational device awaiting FDA review)
  • Rochester Institute of Technology (RIT)’s smart toilet seat (which Editor Charles punningly referred to here) was tested with heart failure patients. It measured nine clinically relevant features, including weight, single-lead ECG, systolic/diastolic blood pressure, blood oxygenation and localized pulse timing, and a ballistocardiogram (BCG) for measuring the mechanical forces associated with the cardiac cycle. Normally, the patient would have to use several devices for these measurements rather than taking a seat. Speaking of the seat, it is standard white and replaces the one in the bathroom. Results were published in JMIR mHealth and uHealth.
  • ResMed’s connection of its continuous positive air pressure (CPAP) sleep apnea treatment devices to the cloud before the patient uses them, plus their patient smartphone app helps them to claim that 84 percent of new users reach the necessary usage threshold for Medicare adherence in the first 90 days of treatment.
  • Clarify Medical’s build-in of user feedback for its home vitiligo and psoriasis treatment that goes direct to their in-house customer service also registers patient usage, needed fixes, and outreach to those who need additional coaching and training.
  • Livongo’s acquisition of myStrength’s behavioral health app [TTA 31 Jan] also points to the importance of consumer behavior in a somewhat different aspect–the 20 percent and more who are struggling with behavioral health issues along with one or more chronic conditions managed by Livongo for employers and health plans.

How to design home healthcare devices that people will use (Medical Design & Outsourcing)

 

News roundup: of logos and HIMSS roundups, Rock Health’s Digital Health Consumer Adoption survey, and the millennial/Gen Z walkaway from primary care

February 21, 2019 | by

HIMSS19 was last week. Onsite reports to this Editor declared it ‘overwhelming’, ‘the place to be’, ‘more of the same’, and ‘stale’. With a range of comments like these, everyone’s HIMSS is different, but HIMSS is well, a place that for most of us in digital health, have to be (or their companies have to be). It is still a major commitment, and if you are small, a place where you might be better off with no display and simply networking your way through. 

HIMSS must be conscious of a certain dowdiness, because HIMSS is ‘reforming’ with a preview of a new logo and graphics here that changes out their Big ’80s curvy lettering and muted colors to hard edges in typefaces and equally hard blues.

Mobihealthnews (a HIMSS company) delves into blockchain (Boehringer Ingelheim and IBM Canada) and Uber Health’s continuing foray into non-emergency medical transport. Dimensional Insight’s blog takes some of the sessions from the data governance and healthcare business intelligence perspective, including the opioid crisis, AI to detect cancer (the link between falling hemoglobin rates and a cancer diagnosis), and pediatric disease registries. And there is the always incisive HISTalk with last Monday Morning’s Update, their 2/14/19 roundup, and Dr Jayne’s Curbside Consult on John Halamka’s world travels, including nascent care coordination in China and interoperability in Australia.

Rock Health’s survey of consumer attitudes towards digital health adoption leads with these insights:

  • Wearable use is shifting away from fitness toward managing health conditions
    • There was a 10% increase in use of wearables to manage health, corresponding to a 10% decline in physical activity tracking
  • Telemedicine adoption is climbing, with urban consumers more than twice as likely to use live video telemedicine than rural consumers
    • Paradoxical but true, in terms of adoption of at least one form, it was 67 percent for rural residents and 80 percent for urban residents.
  • Highly trusted entities like physicians and health plans lost credibility in 2018—consumers were less willing to share data with them than they were in 2017. There’s an increasing distrust of ‘big tech’ and confidence in their ability to keep private data private–a wise takeaway given the Cambridge Analytica and Facebook scandals.

More acceptance of healthcare tools, less intermediation–and not trusting that data is secure spells trouble down the road unless these issues are addressed. Rock Health surveyed 4,000 respondents of US adults age 18 and over.

They’re not trad, dad. Accenture’s survey (released at HIMSS) also tracks the rejection of intermediation and gatekeepers when it comes to millennials and Gen Z in choosing non-traditional modes of healthcare, such as retail clinics, virtual and digital services. They are two to three times more likely than boomers to dislike in-person care; over half use mobile apps to manage health and use virtual nurses to monitor health and vital signs. Over 40 percent prefer providers with strong digital capabilities. Also Mobihealthnews 

The Theranos Story, ch. 58: with HBO and ABC, let the mythmaking and psychiatric profiling begin! (updated)

February 20, 2019 | by

This Editor thought that her next articles about Theranos would be trial coverage. There are court dates pending for Elizabeth Holmes and Not-So-Sunny Balwani–with the DOJ for 11 counts of wire fraud [TTA 16 June] and, for Mr. Balwani, with the SEC on (civil) securities fraud [TTA 15 March]. 

Instead, Theranos hits the headlines again. On 18 March, there’s the debut of an HBO documentary on Theranos. Titled The Inventor: Out For Blood In Silicon Valley (YouTube preview), we can treat ourselves once again to the SteveJobs-esque presence of Ms. Holmes, down to the unnaturally deep voice, blondined hair, and wide blue eyes, unpacking the deception and fraud that was part of the company from early days. But that’s not all! There’s a six-part ABC Radio ‘Nightline’ docu-podcast that started on 23 Jan and airs in six parts through February, which includes audio of depositions taken of board members, whistleblower Tyler Shultz, and patients affected by bad test results. (This Editor will give a listen on this alone.) Episode 5 and links to 1-4 are here via Yahoo.

On websites, we’re regaled with rehashes. The articles range from Teasing the Doc to Where The Ex (Balwani) Is Now (they don’t know) to What Is Her Net Worth (not $4.6 bn). There’s even a flurry of sensational podcasts and videos on YouTube–just Google them. 

Fascinating Fraud. There’s fascination in The Long Con perpetrated by the principals, and less examined, our tendency to Want To Believe. Many of us like legal procedurals and the drama inherent in them (the eternal appeal of the long-running Law & Order in several countries.) Let’s face it, there’s a substantial dollop of schadenfreude mixed in.

What we are witnessing is the building of a myth, increasingly divorced from the real world where it happened, and not improbably or with superpowers. 

Where it goes a little off the cliff. There is a curious article in Forbes that is written by a contributor who writes and teaches courses on stocks and entrepreneurship. He interviewed a former neighbor of Ms. Holmes, Richard Fuisz, MD. It turns out this psychiatrist, inventor, and former CIA asset knew her in childhood. The families were friends and Dr. Fuisz helped out her father when he hit a bad patch. There’s some sketchy profiling in this article, but it does make a fair attempt to get to the heart of the forces that put the gap in Elizabeth Holmes’ ethical makeup, including the Big Steal of Ian Gibbons’ IP. His position is somewhat complicated by a patent dispute (settled) between Dr. Fuisz & Son and Theranos. He’s still hammering on at it on Twitter (@rfuisz).

What’s missing? Much credit to the estimable John Carreyrou, who broke the story in the Wall Street Journal and got his livelihood (and perhaps a few other things) threatened a few times by Tough Guy Lawyer David Boies.

(Updated) At least it is here in a Vanity Fair article on the Last Days of Theranos, where they had to move to downscale Newark (California) and Ms. Holmes’ dog pooped where he wanted to poop. Her ‘persecution’ doesn’t seem to faze her from living in SF, frequenting cafes with said dog, and her new romance with a ‘younger hospitality heir’–a far cry from her former employees who wear the months or years of their lives at Theranos like a Scarlet Letter as they look for work and loose cash in the sofa.

We’ve gotten to the point where the hard business analysis ends and the looser parts of psychologizing begins, as we attempt to understand why. Beyond a certain point, does why matter when damage to real patients has been done? Collateral damage persists in funding of startups and for entrepreneurial women in health tech.

For this Editor, she looks forward to the warmer weather, when it’s expected when the Legal Action–and reality–resumes. 

From our archives: a long buried advert (RIP Bruno Ganz)

February 17, 2019 | by | 2 Comments

On Friday the death was announced of that fine Swiss actor Bruno Ganz. Outside German speaking countries (and ‘Wings of Desire’–Ed. Donna) he was best known for his role in the film Downfall in which his passionate portrayal of Hitler in the bunker spawned thousands of subtitled parodies.

It reminded me and Editor in Chief Donna Cusano that in 2011 we produced our own version as an advert for our ability to show video advertisements. In the end we didn’t use it; mostly because we felt that the genre was slightly passé and also on grounds of… well, taste!

However, as our own little tribute to Bruno Ganz for giving so many people so much pleasure, we have dug it out of the archives and we are sadly surprised to see how well it has stood the test of time.

We hope you enjoy it and, if it inspires you to advertise, please email Donna.

Roy Lilley’s tart-to-the-max view of The Topol Review on the digital future of the NHS

February 14, 2019 | by

Well, it’s a blockbuster–at least in length. Over 100 pages long, and in the PDF form double-paged, which will be a tough slog for laptop and tablet readers. It’s Eric Topol’s view of the digital future of the NHS and it’s…expansive. In fact, you may not recognize it as the healthcare world you deal with every day.

Our UK readers may not be so familiar with Dr. Topol, but here you can get a good strong dose of his vision for the NHS’ future as delivered (electronic thunk) to Secretary Hancock. I haven’t read this, but Roy Lilley has. You should read his 12 February e-letter if you haven’t already.

Here is a choice quote: It’s a mixture of science faction, future-now-ism and away-with-the fairies.

Here’s some background. The Vision’s been around for awhile. Dr. Topol thinks and talks Big Picture, in Meta and MegaTrends. His view is patient-driven, self-managed, with their genomic sequenced and at their fingertips, with the doctor empowered by their records, his/her own digital tools for physical examination, with AI to scan the records and empower a partnership model of decision-making.

Topol In Person is quite compelling. This Editor’s in-person take from the 2014 NY eHealth Collaborative meeting is a review of vintage Topol. His expansive, hopeful view was in contrast to the almost totalitarian view (and it is fully meant) of Ezekiel Emanuel, with his vision of the perfectly compliant, low choice patient, and squeezed like a lemon medical system. At that time, I concluded:

One must be wary of presenters and ‘big thinkers’–and these doctors define the latter, especially Dr Emanuel who looks in the mirror and sees an iconoclast staring back. Fitting evidence selectively into a Weltanschauung is an occupational hazard and we in the field are often taken with ‘big pictures’ at the expense of what can and needs to be done now. Both Drs Topol and Emanuel, in this Editor’s view, have gaps in vision.

A year later, I reviewed his article The Future of Medicine Is in Your Smartphone which came out at the time of ‘The Patient Is In.’ which was quite the succès d’estime among us health tech types. “The article is at once optimistic–yes, we love the picture–yet somewhat unreal.” It seemed to fly in the face of the 2015 reality of accelerating government control of medicine (Obamacare), of payments, outcomes-based medicine which is gated and can be formulaic, and in the Editor’s view, a complete miss on the complexities of mental health and psychiatry.

Back to Roy Lilley:

There is an etherial quality to this report, spiritual, dainty. The advisory panel is 70 strong.

Studies and citations galore, from the world’s top research organizations. The advisory board–I believe well over 70–there’s not a soul down in the trenches running a hospital. Government, academics, and a few vendors (Babylon Health, natch). A lot of emphasis on AI, genomics, and training for ‘collective intelligence’. After reading but a few dizzying, dense pages, I admire the vision as before, but wonder again how we get from here to there.

Roy’s essay is a must read to bring you back to reality. 

Robots’ largely positive, somewhat equivocal role in therapy for children with autism and cerebral palsy (HIMSS)

February 14, 2019 | by

A Georgia Tech study presented at this week’s HIMSS19 conference presented findings of an eight-week study of children with specific neurological conditions who were assisted by robotics in specific therapies for movement and cognition. The study began with the simple attraction of children to robots. Robots also don’t have the negative connotations of therapists, and in fact, based on the studies cited, robots  are more trusted than humans by both adults and children.

For a child, robots ‘repetitive and predictable interactions’ can be reassuring (like Pepper in a Belgium hospital two years ago) , along with ‘gamified’ therapies and child-robot direct interaction as well as therapist-guided. The study’s approaches took several forms:

  • Virtual reality therapy games
  • Guided physiotherapy in movement–gross and fine motor skills
  • Cognitive therapy to improve attention span
  • ‘Gamified’ therapy
  • Robot therapy coaching
  • Tablet-based games

At the start of the study, physical and cognitive baselines were taken and retested at four weeks. By eight weeks the difference in movement parameters between normally developing children and those with cerebral palsy had largely equalized. In a second study, when the robots were withdrawn, their improvement decreased, but not back to baseline. The researchers’ concern was of course, dependency on the robots for therapy on a long term basis. HIMSS presentation by Ayanna Howard, professor of robotics at Georgia Tech is currently online–view quickly as usually they are withdrawn shortly after HIMSS is over.  Mobihealthnews

The wind may be even stronger at the back of telehealth this year–but not without a bit of chill

February 13, 2019 | by

Late last year, this Editor noted that ‘the wind may finally be at the back of telehealth distribution and payment’. The expansion of telehealth access for privately issued Medicare Advantage (MA) plans, state-run Medicaid and CHIP (Children’s Health Insurance Plan) plan members, and this year’s Medicare Physician Fee Schedule, along with a limited expansion of telemedicine in the Value-Based Insurance Design (VBID) model for MA announced earlier this year by CMS, is a leading indicator that government is encouraging private insurers to pay doctors for these services, who in term will pay vendors for providing them.

The Veterans Health Administration (VA) has historically been the largest user in the US of telehealth services (home telehealth, clinical video telehealth, store-and-forward). They are also a closed and relatively inflexible system (disclosure–this Editor worked for Viterion, a former RPM supplier to the VA). In 2017, under then Secretary David Shulkin (who left under a cloud, and not an IT one), there were hopes raised through the Anywhere to Anywhere VA Health Care Initiative. So the news released at the start of HIMSS’ annual meeting that veterans will be able to access their health data through Apple’s Health Records app on the iPhone, perhaps as early as this summer, was certainly an encouraging development. According to mHealth Intelligence, the key in enabling this integration and with other apps in the future is the Veterans Health Application Programming Interface (API), unveiled last year.

Anywhere to Anywhere is also making headway in veteran telemedicine usage. Of their 2.3 million telehealth episodes in their FY 2018, over 1 million were video telehealth visits with veterans, up 19 percent from 2017. 105,000 of those video visits were through VA Video Connect to veterans’ personal devices. The remainder were real-time interactive video conferences at a VA clinic. The other half were assessment of data between VA facilities or data sent from home (the underused Home Telehealth).  Health Data Management

Virginia also moved to make remote patient monitoring part of covered telehealth services for commercial health plans and the state Medicaid program. The combined bills HB 1970 and SB 1221 will be sent for signature to Governor Ralph Northam, to whom the adjective ‘beleaguered’ certainly applies. National Law Review

But service providers face compliance hurdles when dealing with governmental entities, and they’re complex. There are Federal fraud, waste, and abuse statutes such as on referrals (Anti-Kickback, Stark Law on self-referral), state Corporate Practice of Medicine Doctrine statutes, and medical licensure requirements for telehealth practices. Telehealth: The Beginner’s Guide to Legal Pitfalls is a short essay on what can face a medical practice in telehealth.

A selection of short digital health items of potential interest

February 8, 2019 | by

Editor Charles has taken time off recently from assessing mHealth apps to give us a selection of short news items and event notifications.

CE and FDA certification

This editor recently stumbled over the first list he’s ever seen of approved digital health medical devices. As of today there are some 151 products on there which is hugely impressive. One of the reasons for the relatively poor showing of CE certifications on the list is that there is no official list yet: latest forecasts for Eudamed, which will provide this, are Spring 2020 amid much uncertainty about whether enough Notified Bodies will be approved to certify to the MDR in time. Immediately spotted as a CE certification missing is Walk with Path’s Path Finder device for helping people with Parkinson’s to avoid a freezing of their gait (though CE certification is well hidden on their website) and doubtless there are others. Clearly the list points up potential benefits were it ever possible to harmonise the approval process across the Pond.

Longevity 

The first Longevity Leaders event took place on Monday, perhaps the first large event in the UK on that topic. Based on the enthusiasm of attendees, clearly it won’t be the last. Doubtless in due course it will fragment into a myriad of specialist topics though currently it is a fascinating combination of almost every medical/pharmaceutical and digital discipline, plus housing and a range of other considerations. Timescales varied widely too – for example I talked about the immediate benefits of digital health including keeping people in their own homes, thus minimising sarcopenia from being confined to a hospital bed and avoiding exacerbating dementia by a change of environment, whereas others spoke of how best to make DNA immortal and whether the first person destined to live to 1000 had already been born.

Clinical  Homecare

From the sublime (last item) to the The National Clinical Homecare Association‘s conference on 31st January, where this Editor also spoke on how digital health could help people to be treated in their own homes. Notable was the absence of any Twitter handle for the Association, no hashtag for the conference and just two people it seemed out of 250 using social media. Clearly there are huge opportunities here for digital health suppliers, particularly as so much of what was said by other speakers, and what was being shown in the exhibition was very much manually-intensive stuff: join the NCHA and start a revolution in clinical homecare! 

Recent developments in AI

Since this editor stopped active involvement in conference organisation for the Royal Society of Medicine it is encouraging to see that the younger generation has picked up the baton and is running even harder, such that the above event, on 26th February, has proved so popular that it has been moved to the largest (300 seater) lecture theatre at the Society, and on current sign-up rate will sell out.  Speakers from Babylon, Ada Health, DeepMind, Kheiron Medical, BenevolentAI, UCL Life Sciences & Alan Turing AI partnership, and many more will ensure that delegates gain a comprehensive understanding of how AI is being used across healthcare. Book here to experience the delights of the new RSM all-new website which makes signing up for an event so much easier than in the past. Fear not though: the RSM’s legendary low ticket costs are maintained!

Wayra and Novartis

A most exciting event this week was the announcement of the joint Wayra and Novartis health call now looking for their next cohort of remarkable start-ups to join their new programme called The Health Hub. This is built together with their new partner Novartis, one of the leading pharma companies. Their focus is on how healthtech can be used drastically to innovate long-term disease management. Apply here, by February 17th. Hat tip to Professor Mike Short for this item and other observations in this post .

Rewired Pitchfest

Early health tech entrepreneurs should consider taking part in the Rewired Pitchfest at the Digital Health Rewired Conference and Exhibition, Olympia London on 26 March. Sponsored by Silver Buck, this provides the opportunity for early stage digital health start-ups to showcase their disruptive ideas and prototypes to NHS IT leaders. Applicants will compete before a judging panel featuring investors and successful start-up founders. It’s a great way to gain significant exposure and make connections with a diverse range of UK digital health leaders…and the winner will be announced, and congratulated, by Matt Hancock himself! There is also the chance of winning a mentoring programme with the experts on the judging panel and PR features in Digital Health News. (Disclosure: this editor is on the Programme Committee of Rewired, as well as being a Pitch judge)

Punning headlines

It’s rare that a single item is worthy of its own paragraph on TTA these days however an exception must surely be made for one of the few punning headlines to be found in digital health, especially as it’s for such an old – and until now undelivered – idea: “Smart toilet seat is flush with possibilities to monitor patients’ health”

News roundup: Current Health’s Class II, Healthware Italy’s €10 million boost, the low state of Latin America telemedicine, weekend reading on digital health in health systems

February 7, 2019 | by

Scottish startup gains FDA Class II clearance, pilots with Mount Sinai Brooklyn. Edinburgh’s Current Health has received FDA Class II clearance for its AI-enabled remote patient monitoring wearable monitors. The single arm-worn wearable sends data every two seconds on oxygen saturation, respiration rate, pulse rate, temperature, activity, and posture. Algorithms analyze the data and alert clinicians to patient status and deterioration. The Mount Sinai pilot follows on Dartford and Gravesham NHS Trust for a post-discharge monitoring program, with a 22 percent reduction in home visits plus fewer hospital readmissions and emergency department visits. Current Health is the renamed snap40. Mobihealthnews, BusinessWire release

Healthware, a Salerno, Italy-based consultancy group primarily concentrated in marketing and sales, has received a €10 million investment from Fondo Italiano d’Investimento SGR (FII Tech Growth). The investment will be used over the next two years has received to expand Healthware’s business transformation for life sciences companies and product development and services for digital health start-ups which improve health outcomes through new technologies. Release.  Hat tip to Healthware’s Antonietta Pannella

Telemedicine adoption in hospitals ranges from 65 to below 30 percent in Latin America. A study published this week in Health Affairs Global Health Policy (paywalled) looks at the different rates of hospital-based telemedicine adoption in nine Latin America countries. Leading is Chile with the aforementioned 65 percent; Argentina, Costa Rica, Mexico and Peru with less than a 30 percent. In the middle: Panama (35 percent), Uruguay and Guatemala in the 40 percent range. Despite supportive official policies in many of these countries, “Efforts to implement telemedicine are isolated and scattered, often left to the public sector or taking the form of insulated projects that are not sustained” or scaled up nationally and regionally. Mobihealthnews

For weekend reading. Intersecting with the Latin America story above is this. This Editor missed the October issue of Global Health: Science and Practice published out of Johns Hopkins, but here it is. The focus of the six articles is digital health integration into health systems in the US and internationally. Hat tip to Alain B. Labrique via Twitter

Digital health versus eHealth: ‘here we go again’ with the confusion and the differences. Plus Women in eHealth (JISfTeH)

February 7, 2019 | by

Editor Donna (and Editor Steve before her) always likes a good dust-up about terminology. One of the former’s pet peeves is the imprecise usage of telemedicine (virtual visits) versus telehealth (remote patient monitoring of vital signs); she will concede that the differences have been so trampled on that telemedicine has nearly faded from use.

The Journal of the International Society for Telemedicine and eHealth (JISfTeH) makes a grand attempt to parse the differing definitions of digital health and eHealth in their opening editorial of this month’s (24 Jan) issue. eHealth has fallen so far from use that the few times one does see it is in associations such as ISfTeH and the New York eHealth Collaborative. Even the World Health Organization, which has always been a fair arbiter for the industry, defined eHealth back in the salad days of 2005 as “the use of Information and Communication Technologies (ICT) for health”–broad, but workable. After a witty aside in defining digital health as “an area of healthcare focused entirely on fingers and toes” (plus), and examining the overly broad definitions of Eric Topol and Paul Sonnier, the authors Richard E. Scott and Maurice Mars seem to settle on this: that while digital health is given a  much broader but nebulous definition (to the point of linguistic absurdity cited in Mesko et al.), and may incorporate related technologies like genomics (another poorly defined term) and ‘big data’, it would not work without that ICT. And that at least there’s a settled definition for eHealth, as stated above, for which this Editor assumes we should be happy. In the author’s closing, “Will we be sufficiently motivated to rise to such a challenge-globally agreed universal definitions? If not ……here we go again …..”

This month’s journal theme is also Women in eHealth, with articles on Brazilian eHealth distance education, digital technology in midwifery practice, and how online social networks can work for drug abuse treatment referral. There’s also a change in format, with article links opening to full PDFs of each article.